American Journal of Surgery · Mar 12, 2025

Extra-abdominal CT imaging indicates increased severity of illness in advanced age patients requiring emergency abdominal surgery

By Malhotra L, Stephen AH, Goosman M et al.

BACKGROUND: Abdominal sepsis frequently causes neurologic and pulmonary dysfunction among geriatric patients, We hypothesize that patients with abdominal sepsis who undergo extra-abdominal imaging have a greater burden of illness. METHODS: Patients 65 years and older that underwent emergency abdominal surgery for sepsis were divided into those with abdominal only(AbdCT) versus abdominal and extra-abdominal(ExtraCT) imaging. RESULTS: ExtraCT patients(N = 30) compared to AbdCT(N = 97) had higher rates of dementia(13.3 % versus 3.3 %; p = 0.03), diabetes(93.3 % versus 60.1 %; p < 0.01 and COPD(70 % versus 29.9 %; p < 0.01) but lower rates of abdominal pain as chief complaint (23.3 % versus 81.4 %; p < 0.01) and higher rates of being qSOFA positive (33.3 % vs 7.2 %; p < 0.05). Importantly, time to OR was not different between groups. ExtraCT patients had higher rates of 30-day mortality (33.3 % vs 5.2 %; p < 0.01). Extra-abdominal CT imaging was associated with increased risk of mortality (OR = 5.4; 95 %CI = 1.4-20.1). CONCLUSIONS: ExtraCT among geriatric patients with abdominal emergencies is a marker of severity of illness and should guide end-of-life decision making.

doi.org/10.1016/j.amjsurg.2025.116297 PubMed 40117919 Biomarkers